Correlation between mammography-detected lesion and its pathology among Chinese population - a 5 year retrospective analysis

Abstract

Aim: In this study, we correlated the mammography BI-RADS categories with pathologic diagnoses, aiming to evaluate the performance of mammography in breast cancer detection in the Chinese population and assess any risk factors for discordance. Method: Chinese female patients who had a mammography-detected lesion between 1 January 2016 and 31 December 2020 followed by a surgical pathology report was examined. Patients with lesions visualised by ultrasound were excluded from the study. Results: A total of 327 female patients contributed to 361 episodes with breast mammography and a subsequent breast. There were 40 patients (11.1%) with a negative or probably benign mammography (BIRADS 1, 2 and 3), and three in the BIRADS 3 group had a malignant pathological diagnosis (9.7%, 3/31). They presented with either a strong family or personal history of breast malignancy. All of their mammograms showed a background of dense breast tissue. One hundred twenty-eight patients underwent subsequent removal of lesions, and 21 of them (16.4%) experienced an upgrade in the final pathology. Tomographic guided biopsy has significantly less pathological upgrade post-surgery than stereotactic-guided core biopsy (10.3% vs. 23.3%, p = .05). Patients with denser breasts also experienced a higher likelihood of pathological upgrade (20.2% vs. 7.7%, p = .06). Conclusion: In conclusion, our study indicated that the performance of mammography is inferior for breast cancer detection among the Chinese population compared to the Western data in patients with BIRADS 3, which might be contributed by dense breast tissue leading to a reduction in sensitivity. Tomographic guided biopsy is superior to stereotactic-guided biopsy in our cohort.